|
JOURNY ARTINS BCS STD 5-6 R 15
|
Facility
|
OP
|
$6,796.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.80 |
| Max. Negotiated Rate |
$6,524.16 |
| Rate for Payer: Aetna Commercial |
$5,232.92
|
| Rate for Payer: Anthem Medicaid |
$2,337.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.88
|
| Rate for Payer: Cash Price |
$3,398.00
|
| Rate for Payer: Cigna Commercial |
$5,640.68
|
| Rate for Payer: First Health Commercial |
$6,456.20
|
| Rate for Payer: Humana Commercial |
$5,776.60
|
| Rate for Payer: Humana KY Medicaid |
$2,337.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,015.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,384.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,980.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,912.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.24
|
| Rate for Payer: PHCS Commercial |
$6,524.16
|
| Rate for Payer: United Healthcare All Payer |
$5,980.48
|
|
|
JOURNY ARTINS BCS STD 5-6 R 18
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 5-6 R 18
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 5-6 R 21
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 5-6 R 21
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 5-6 R 25
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 5-6 R 25
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ART INS BCS STD 5-6 R 9
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ART INS BCS STD 5-6 R 9
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L10
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L10
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L11
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNY ARTINS BCS STD 7-8 L11
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNY ARTINS BCS STD 7-8 L13
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L13
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L15
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 7-8 L15
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 7-8 L18
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L18
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 L21
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 7-8 L21
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 7-8 L25
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ARTINS BCS STD 7-8 L25
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
JOURNY ART INS BCS STD 7-8 L 9
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ART INS BCS STD 7-8 L 9
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
